51Cr-EDTA Permeability Test in Ascitic Cirrhotic Patients with and without History of Spontaneous Bacterial Peritonitis

Abstract

Purpose: Impaired intestinal permeability (IP) may be implicated in spontaneous bacterial peritonitis (SBP) pathogenesis in cirrhotics. Urine 51Cr-EDTA is a standardized test for evaluating IP. Since 51Cr-EDTA has a small molecular weight it can be found in peritoneal spillage in ascitcs. Aim of the study was to assess IP in cirrhotics. Methods: 48 consecutive cirrhotic pts (16 for each Child class) were enrolled; 20 pts had ascites, 10 of those had also a history of previous SBP. We also enrolled 48 healthy subjects. In healthy subjects 51Cr-EDTA was < 3%. After an overnight fast, pts were given to drink 2,96 MBq of 51Cr-EDTA in 10 ml of water; two 3-ml samples both of 24/hours urine and ascites were measured by a gamma counter. Urine sample results were expressed as a percentage of administered dose and considered indicative of altered IP when 51Cr-EDTA was ≥3%. The presence of 51Cr-EDTA in the ascites was also evaluated. Results: 22 out of the 48 pts had an altered IP as described by 51Cr-EDTA urine test vs 2 out of 48 controls (46% vs 4%P < 0.05). IP impairment followed progressing Child status: Child A 4/16; Child B 6/16; Child C 12/16. 12 out of 20 ascitic pts vs 10 out of 28 non-ascitic pts had an impaired IP (60% vs 36%P < 0.05). 8 out of 10 pts with ascites and SBP history had an impaired IP vs 6 out of the 12 ascitics without SBP history (80% vs 50%; P < 0.05). 51Cr-EDTA was present in ascites samples from all ascitic pts with history of SBP vs 2 out of the 12 pts with ascites without SBP history (100% vs 22%; P < 0.05). Conclusion: a consistent number of cirrhotics have an altered IP. IP derangement was associated with more severe disease status (ascites and history of SBP). The presence of 51Cr-EDTA in ascites in all pts with an history of SBP suggests an altered permeability of the splancnic vessels and/or peritoneal membranes. Further studies are needed to assess a 51Cr-EDTA urine and ascites cut-off where SBP profilatic therapy could be indicated.